This month we are focusing on the importance of quality sleep for the family in the postpartum period. Julie Bindeman, Psy-D, Co-Director of Integrative Therapy of Washington sheds light on how sleep deprivation affects the body and mind, and how to utilize support to increase the quantity and quality of sleep. Integrative Therapy of Greater Washington is a psychology practice located in Rockville, MD that specializes in reproductive psychology and family therapy.

"All expecting mothers have heard the infamous and annoying advice, “sleep before the baby comes” as if sleep is easy to come by during pregnancy itself. This unsolicited advice usually is given with good intentions. What people are trying to tell you is that you’re going to be the most tired you’ve ever been in your life. While most people know this intellectually, living it is quite a different experience.​

It comes as no surprise to new parents that they are utterly exhausted during the newborn and infant period. However, this time frame of sleep deprivation combined with learning new skills can be totally overwhelming and leave parents feeling hopeless and worn out. Below we discuss the impact sleep has during the post-partum period and how to find support in maximizing your rest time.​Its Impact PhysiologicallyDuring the postpartum period (typically from 0-4 months after birth), women are going through extreme physiological changes. After 9 months of rapid changes within the body during pregnancy, the process of returning to a new normal begins. Major organs are returning back to their usual place and size, hormones are coursing through the body, and milk production is in full swing. Just this process alone is exhausting, let alone the interrupted sleep patterns that come with having a newborn.

Sleep has a big impact on the body even without all of the added physiological changes occurring in the postpartum body. A lack of sleep can cause physical fatigue, manifesting in symptoms that may be attributed to other causes. Some frequently missed symptoms of physical fatigue include an interrupted circadian rhythm and inflammation that can lead to gastrointestinal issues. Both of these symptoms may be overlooked due to waking up every two hours to nurse a baby, and GI issues that are caused by a response to pregnancy and delivery. Not getting enough sleep also affects the hormones in the body. According to the National Institutes of Health, the release of counterregulatory human growth hormone and cortisol are impacted by the quality and quantity of sleep the body is getting. A lack of sleep will disrupt the release of these hormones causing issues to appetite regulation, glucose tolerance and the circadian rhythm.

It’s Impact on Mental HealthSleep deprivation can cause many negative impacts on your mental health as well. It contributes to poor attention and decision making, inability to perform routine tasks and an increase in anxiety, mood swings and irritability. People struggling with a lack of sleep find themselves easily frustrated or angered and struggle with coping skills. All of these factors will also contribute to suffering in relationships with those around you. You may take your irritability out on your partner, close friends and family, and maybe even your baby, which might look like snapping, being curt, or being sarcastic. Even if you are not dealing with postpartum depression, sleep deprivation can contribute to mood swings and unpleasant moments.

Postpartum DepressionResearch suggests that sleep deprivation can be a contributing factor to postpartum depression. It can also be a symptom of postpartum depression presented through insomnia or an inability to rouse. Sleep quality is controlled by the same neurotransmitters in the brain that affect mood. Many women may attribute difficulty in sleeping during those first months to being on the schedule with their baby and overlook that it may be a symptom of a postpartum mood disorder. The Journal of Obstetric, Gynecologic & Neonatal Nursing conducted a survey and found that postpartum depression symptoms worsen for patients when the quality of sleep declines. Sleep is one of many factors contributing to postpartum depression, but one of the most important to address. Being well rested can help a new mother focus on managing her depression and ultimately recovering.How to Get More Quality SleepMost new parents are aware of the toll sleep deprivation takes on the mind and body. It’s not a lack of awareness that is the issue, but rather a lack of resources prohibiting them for getting the sleep they need. Here are some practical tips to help with getting more quality sleep. Utilize a Support Network

Don’t be afraid to ask for help, and take people up on their offers. Whether they offer to cook a meal, watch your older child, or even come and snuggle with baby while you nap, accept them! This tends to be hard for Americans to do as we are used to the mentality of “picking ourselves up by our bootstraps,” but it really does take a village.Look into hiring a postpartum support doula to come overnight a few nights a week or to come and help during the day. Their presence will be invaluable in maintaining a peaceful and functional home. Don’t be afraid to reach out for professional psychotherapy support. There is so much going on within the mind and body during the newborn and infancy months, speaking with a licensed professional can help bring perspective and give you skills to navigate parenthood in a healthy way. There’s a reason why the saying “it takes a village” has stuck around, it truly takes a community to keep a family healthy and thriving. Have Realistic Expectations

Remember that the postpartum period is much longer than 6 weeks. Recent studies have found that a woman’s body still has postpartum effects one year after giving birth. After the major physical healing has occurred, the family is still enduring big changes as both parents return to work, or one parent is taking the lion share of caring for the baby. Don’t expect that you’ll still be able to do everything at full tenacity without a lot of help, or a lack of sleep. Minimize Sleep Hindrances

Caffeine- although caffeine may seem like a lifeline during this exhausting period, try to limit the amount being consumed. It does affect your ability to fall asleep and the quality of sleep overall. If you need your caffeine (and we’ve all been there), try to consume it in the morning, and don’t take in more after 4pm.

Electronics- try to make the bedroom an electronic free zone. Screens increase the hormone melatonin in your body giving you the physical cue to stay awake. Try to avoid electronics during late night feedings as well. They will make it take longer to get back to sleep. This means that finding a space that isn’t your bedroom to charge your phone is ideal.

It is unrealistic to expect that your sleeping will return to normal shortly after having a baby, as typically, it takes infants several months to start to regulate their own sleeping patterns. Yet it is still important to be cognizant of the quantity and quality of sleep you are receiving. While you may not be able to get the full amount of sleep you’d like during this time, there are ways to keep the family and yourself healthy. Build in restful times for yourself throughout the day even if you aren’t sleeping, accept help from others and seek the support from professionals to make the most out of the sleep you can get. If you find yourself needing more support in adjusting to your family’s new normal, contact Integrative Therapy of Greater Washington to discuss what therapy might do for your unique situation. ​

As the temperature rises, you may be looking for tips about where to take your baby or toddler and how to deal with summer -- sun, heat, bugs, and water. Here are our best tips and tricks for tackling this season with your child.

SUN SAFETY

Infants are particularly vulnerable to the sun's damaging rays, no matter their complexion. Research shows that early exposure and sunburns actually have a multiplying effect on the risk of developing skin cancer later in life.

The American Academy of Pediatrics (AAP) recommends limiting the use of sunscreen on children under six months. Instead, avoid bright sun on your babies, using lightweight long pants and long-sleeved clothing or sunshades to create a barrier.

Consider swimwear that covers more of your baby's body, like a long-sleeved rash guard. Bucket hats and baby sunglasses are super cute and protective, if your baby will tolerate them.

Stroller and car seat covers can be used to shield an infant, and you can drape lightweight blankets over wraps and carriers to provide an extra sun barrier.

Typical muslin blankets provide only a small amount of sun protection. Consider a special blanket for the summer that provides a higher level of protection without affecting the lightweight fabric, like this.

If you need to use sunscreen on young babies, use a small amount and focus it on areas that cannot be easily covered, like their faces and hands.

When children are older than six months, choose a sunscreen that is easy to apply, has a high SPF/UPF rating, and reapply every two hours.

HEAT SAFETY

Children under three years old cannot regulate their body temperatures as effectively as adults.

Be especially mindful in warm weather, especially when there is a change in routine, so your child is not unintentionally left in a hot vehicle. There are commercial alarms that can help remind you, but a simple practice like a clothespin on your seatbelt or placing your cellphone in the back seat can help remind you when your child is in the car.

Children under six months old typically get all the hydration they need from breastmilk and/or formula. Older babies may be offered sips of water, and in the summer, offering cool drinks can help keep your babe from overheating.

When the temperature really rises, you can use extra breastmilk or formula in popsicle molds to create a cold treat for your baby. Be careful that your baby can't choke on any hard or icy bits by using a teething mesh feeder.

BUG BITES

More than just an irritation, parents are also concerned that bug bites transmit disease to their young children. But the AAP recommends not using chemical insect repellent on children younger than two months. For your youngest children, use long pants and long-sleeved shirts, hats, and stroller netting where appropriate.

For babies older than two months, choose a repellent with the lowest percentage of DEET that will be effective for your situation. Note that the AAP recommends a maximum level of 30% DEET, reporting that higher levels do not offer additional protection. Always consult your baby's pediatrician before use.

Be careful with aerosol application of insect repellents. Consider spraying the product on your hands and rubbing it on your child to avoid spraying in or around his eyes and mouth..

After outdoor play, examine your child for ticks or new insect bites. Bath time is a great time to examine your child's full body, and you can wash away the day's sunscreen and insect repellent before putting on pajamas.

WATER PLAY

For many families, summer means trips to the pool, beach or lake. Vigilance is key when you have your baby in or around water -- be clear which adult is responsible for keeping eyes-on the kids so there is no doubt that someone is watching.

Wading pools and splash pads are a great way to introduce your young ones to water play, though they will still need close supervision. At splash pads or spray parks, be sure your baby has protective clothing and shoes when appropriate -- especially for early walkers.

Water play is possible without a pool or special swimwear. Give your baby a paintbrush and a small bucket of water and let him paint the sidewalk! Spray bottles and large sponges are endless fun for young children, especially when given a grown-up task like cleaning toys. Even muffin tins with ice cubes on a towel in the kitchen can give a baby cool water experience. Be creative and remember everything you offer could be put into his mouth.

Summer is a wonderful time to explore the outdoors with your baby, and these simple precautions will make it safer to get out and play. So get out there and enjoy; before you know it, we will be bundling up again!

Many of the families we work with use bottles with their infants. It can be used as the primary way to feed the baby, as a supplemental tool, or in transition to both parents returning to work. Though it seems pretty intuitive -- insert nipple to baby's mouth -- we do have some tips for making the best of your bottle feedings.

It is our instinct to encourage big meals in our children -- feeding is one of the primary ways we care for our young children. However, too much food too fast is not ideal for newborns and infants, whose small stomachs require many small meals in a day. Overfeeding or feeding too quickly establishes habits that can affect how your child eats into adulthood.

Paced bottle feeding is a technique that mirrors breastfeeding to ensure your baby is getting the amount of food she needs at a speed that works for her small body. Here's how it works:

1. Use the smallest size flow bottle nipple available. Typically these nipples will be labelled preemie, though they can be used at any age. Using a slower-flow nipple will require the baby to use his sucking reflex to get milk*.

2. Sit the baby upright, not lying down, in your arms. Again, this reduces the pressure of milk flow into the baby's mouth and requires some action on his part. This sucking more closely mirrors breastfeeding, and the upright position reduces ear infection rates.

3. Hold the bottle horizontally, not tipped at a steep diagonal. The nipple should have milk at the tip, but you do not need to tip the bottle to fill the nipple chamber with milk. In fact, sucking on an empty nipple will not automatically fill your baby with gas -- sucking on air does not mean swallowing air.

4. Time the feeding to last 10-15 minutes, the approximate time of a breastfeeding session. Though it can be convenient for a feeding to go quickly, eating too fast means that infants may take in more than they need to be satisfied. We want the newborns to learn to eat to satiety, not to overstuffed.

5. Switch sides halfway through the bottle. Babies learn habits quickly, and it is important to give them a variety of poses for eating -- not just to keep flexibility in feeding, but to encourage symmetrical development of eye focus and muscle coordination.

6. Follow signs from your baby. If he is turning his head away or seems to want to take a break, follow his lead. When at the breast, babies take frequent pauses between swallows. This pattern of sucking, swallowing and pauses can be mirrored with a bottle. Plus, you don't have to finish every drop of every bottle.

*Note: the word milk is used here but refers to breastmilk and formula equally.

We hear from parents concerned about periodic bottle use that their infant may develop "nipple confusion." Paced bottle feeding can help prevent nipple confusion, which may more accurately be called "flow preference." If the bottle feeding mirrors the experience, pace, and quantity of breastfeeding, it will likely be easier for your baby to switch back and forth.

If you have questions about this or other bottle, pumping, or breastfeeding issues, please get in touch with us! Metropolitan Doulas is here to help your family.

Looking at this list may make you want to laugh or cry (or laugh-cry simultaneously). But remember, an infant’s cry is a reflex, not an emotional statement. Make your baby as safe and comfortable as you are able to, and don’t be afraid to ask for help when you need it. We are here for you!

Many new parents wonder if they are providing enough stimulation for their newborn babies. With music, toys, classes, and playgroups targeted for infants and even newborns, it is understandable that some parents may think this is what their children need. When should you start playing with your baby, and what does that look like?

​In the first weeks of life, just being awake and feeding are enough stimulation for your baby. Seeing you, hearing your voice, smelling milk, and sensing the warmth of a parent’s body help develop their senses and give them all the stimulation they need.

You will notice when your baby begins to spend longer stretches awake and look around more -- usually around week 3, though it depends on your baby. This may be a good time to start offering high contrast images for the baby to study. You can find baby toys to or simply use what you have -- a graphic pillow or swaddling blanket. See some of our recommendations.

Be sure to use your voice -- narrate what you’re doing with him, sing songs, or read aloud. You can sing children’s songs and read board books, or belt out your favorite pop song and read the Washington Post aloud. At this stage, it is about the sound, not the content, of your speech. Check out this amazing Ted talk to learn more about how infants learn language and why it's important to speak to them from a young age.

At about six weeks, your baby will be able to engage with you more. He will make longer eye contact, verbalize, or even smile intentionally! Though it may only last 10 minutes at a time, this quiet and active state is a great time to engage in “conversation.” This is the time when he learns about human speech patterns and facial expressions.

You can overstimulate newborns. Providing too much play can leave your baby “wired” and too wound up to sleep or settle down to feed. So if your baby resists engaging with you, leave it for another time. There’s no rush, and you’re not missing your chance.

You can also take advantage of the many opportunities for young babies in our region. Sometimes getting out of the house and having a structured activity is as useful (or more!) to the parent than the baby. We love the activities and classes and Lemon Tree Playgroup in DC.

Calming newborns is a mainstay of our job as doulas, along with teaching new parents our best tips. Many parents and doulas find helpful the strategies of Dr. Harvey Karp, author of Happiest Baby on the Block. Dr. Karp advises trying the “5 S’s”, outlined below, to simulate what an infant was used to while in the womb. Here is our take on the 5 S’s strategy.​

1. Swaddle: A good swaddle can aid in long sleep sessions by preventing startle reflexes from waking the baby up. Done properly, the swaddle can recreate the closeness of the womb and provide warmth. It takes some practice to perfect a swaddle, and some commercial swaddles use velcro for extra security. For more on swaddling, check out this fact sheet from the American Academy of Pediatrics. Also, see our favorite swaddles here.

​2. Side: Try holding your baby on his side and against your body. You may like to start stomach to stomach, cradling the baby’s head in your elbow. Dr. Karp advises that laying your newborn on his left side can aid in his digestion, and we find that babies are soothed by the body contact. Amazingly, babies as young as a few days old can have strong preferences for being held on their side or upright. If your baby has strong preferences, you will learn quickly from her cues as you try different positions.

3. Shush: In the womb, babies hear a constant whoosh of noise -- a combination of sounds from the real world and from the mother’s body itself. Dr. Karp recommends recreating these sounds by “shushing” your infant or using fans and white noise. Sometimes running water, like the sound of the shower, or even the bathroom fan is sufficient to calm the baby. In combination with some of these other strategies, white noise can be very calming to your infant.

4. Swing: Many parents find they unconsciously sway or jiggle when they hold their newborn. This parental reflex is fulfilling the baby’s need for movement, something they were used to in utero. Dr. Karp describes it as a “jiggle.” Many products are available to move your baby -- bouncy seats, swings, rockers, and vibrating chairs -- but the movement of your body will be most familiar to the newborn and also satisfies their desire for closeness. You can’t hold and rock the baby all the hours of the day, however, and that’s why finding what kind of seat works best for your baby can be very valuable.

5. Suck: Newborns’ strongest reflex is to suck, and they generally find it very calming. Many new parents find they offer the breast or bottle first for fussy infants. If you determine the baby is not hungry, you may choose to offer a clean finger or pacifier to satisfy the sucking reflex and help calm your baby. For more on pacifier use in newborns, see our previous blog post. To offer your infant a finger to suckle, insert your clean pinky finger, nail down, into the baby’s mouth. The soft pad of your finger should feel the baby’s palate at the top of his mouth.​Try using these strategies in different combinations; you don’t need to use all five at once to soothe your baby. Dr. Karp recommends these strategies be used up to four months of life, at which point your child may outgrow the reflexes that respond to them.

Not all babies are the same, and not all parents will find these methods the best fit for your family. However, these are some great tools to try as you learn what your child prefers. ​

As Postpartum Doulas, some of the most common questions we hear from new parents are about how to bathe their newborn. How soon after birth should you give your baby a bath? How often should the baby get a bath? What equipment do you need? What are some tips and tricks for a successful bath? Never fear -- we can help put your mind at ease as you learn this new skill.

​How soon after birth should regular bathing begin? Infants delivered in the hospital generally receive a bath on their first day of life. Procedures vary between hospitals, so ask your health professionals for details of your newborn’s care. Once you have the baby at home, it depends on your preference and your baby’s needs. Generally, babies are pretty clean and they have very delicate skin, prone to drying.

During their first weeks, they are thoroughly cleaned in the diaper area several times a day, along with clean-ups related to feeding. So, you can go a week or even longer without a full body wash -- it is up to you.

How often should the baby get a bath? Because baby skin is very sensitive, it can actually be more harmful than good to overwash your newborn. While bathtime is a useful tool in a bedtime routine for older babies, a newborn will not generally associate bathing with night, so establishing a bathing routine is more likely for your benefit than the baby’s. Ask your pediatrician if there are any reasons you should wash your child more or less frequently, based on your child’s specific needs. Otherwise, 1-4 times a week or so should be fine.

What equipment do you need? There are many infant seats and bathtubs available for purchase. They can be useful but are not mandatory. Be sure you have several dry towels, a few washcloths, and a gentle soap on hand. The most important note about equipment is that you must have everything you need right at hand before you start. Once the baby is naked and/or wet, you will need hands on the child at all times. There is no pausing the bath to grab an extra washcloth. NEVER LEAVE YOUR CHILD UNATTENDED DURING A BATH.

What are some tips and tricks for a successful bath?

Do not submerge babies who retain their umbilical stump. Until the umbilical cord is completely healed, the American Academy of Pediatrics recommends only sponge baths.

Wet babies are very slippery! Use washcloth gloves or even submerged towels to give you a better handle, literally, on your baby’s body. Towels can be used to line baby bathtubs or even on the floor of your regular bathtub with a few inches of warm water. Just be sure to keep floating towels away from your baby’s face.

Handling your baby in the water can be tricky. Focus on holding the head -- that’s where much of your child’s weight is and the part you want to keep above the water line. Many parents find it useful to constantly keep one palm under the newborn’s head while the other hand washes.

Pay attention to skin folds for special cleansing. Newborns tend to clamp their fingers and toes. As a result, they occasionally accumulate fuzz or milky residue in the creases of palms or between toes. As they pack on the pounds, check under the neck for drool and milk and in those adorable thigh creases for anything missed during diaper changes.

Test shampoos and lotions on skin before using it all over their body, or even stick to just warm water for the first few bathings.

Use the kitchen sink or countertop for baths as you learn your new bathing routine. It is easier to wash a baby while standing than hunched over or kneeling on the floor. Just be sure you have a good grip on baby at all times.

Newborns typically don’t like to be naked and completely unencumbered -- as when they are lowered into a bath. The Moro reflex will be triggered, and it is likely your baby will flail and/or cry during transition into and out of the tub. No need to panic; just try to make those transitions as quick as possible.

Use warm -- not hot -- water. Try testing the temperature with your forearm or elbow, where your body temperature is more consistent. Keeping the air warm can help ease the transition into and out of the warm water.

Warm water also triggers urination. It may happen in the tub. It may happen in the towel. It may happen all over your shirt. But it’s likely to happen at some point during bath time.

During the first few weeks with a newborn, loading everything up and venturing out for a cup of coffee can seem impossible. What if the baby needs to eat? What if she poops? You’re too sleep-deprived anyway -- isn’t it easier to just stay home?​

There are several benefits to getting out of the house, though. As soon as your physical recovery allows, the American Congress of Obstetricians and Gynecologists (ACOG) recommends 20-30 minutes of daily activity to rebuild muscle and combat postpartum mood disorders. It is a way of reconnecting with the “real world” and exercising your new self-identity as a parent. In addition, many parents find babies are more relaxed when outdoors, even as newborns.​

So how do you get out of the house with a newborn? First, figure out how you’ll transport the baby. If you’re driving, obviously you’ll use the car seat. But once you get to your destination, does it make sense to carry the car seat or would it be easier to wear your baby in a sling or carrier*? Some parents choose to bring a couple of options until they have a bit more experience.

Second, organize your gear. If you feel that you have what you need -- diapers, wipes, a spare set of clothes, burp cloths, blanket, pacifier or bottles (if applicable) -- you’ll feel more confident in case things don’t go smoothly. Many items can do double duty; for example, a muslin swaddle blanket can serve as a shade over the car seat, a nursing cover, a burp cloth, and even a changing pad.

Third, case the joint. When you get where you’re going -- whether it is Target, a new parent support group meeting, or the neighborhood coffee shop -- take a minute to figure out where you can retreat if you or your baby needs to take a break. Is there a place where you would feel comfortable nursing or bottlefeeding? Where is the best spot to change a diaper? With a plan in mind, you can relax and enjoy your outing.

Fourth, rely on the kindness of strangers. Everyone who has ever had a new baby -- and many who have not -- have empathy for new parents. Try not to anticipate frustration; they want to see you succeed! If you need to abandon your full grocery cart to flee back to the car, no one will think twice!

When you go out, where can you go with an infant? During winter months, many pediatricians advise against taking newborns to indoor public places to prevent RSV or flu infection. Check with your physician about any reason your baby shouldn’t be out. Generally speaking, however, babies can go wherever you would regularly go.